Question of the Month: Heel Pain after sports in a 10 year old basketball player...
My 10 year old son plays basketball and he is getting really sore after playing games. He keeps pointing to his heels and even limps sometimes. What is it? He didn't start the game limping.
The Most Common Cause of Heel Pain in kids is....
Sever’s Disease (also known medically as calcaneal apophysitis)
Sever’s disease occurs at the ankle and is the most common cause of heel pain in children age 5-11. This disease was named after Dr. James Warren Sever who first described the disorder in 1912. The pain is caused by inflammation that occurs at the growth plate (called the apophysis) at the heel bone (called the calcaneus). This disorder is irritated by physical activity such as walking, running, and jumping. Sometimes this pain can be so severe that you may see your child start to limp after practice or games. This pain can be worsened by increases in the duration (amount time playing) or the frequency of practices and games.
What's going on inside the body?
Running, jumping, and even walking can cause tension and tightness in the calf muscles. These calf muscles (called the Gastrocnemius and Soleus), join together on the backside of the lower leg and attach to a large tendon called the Achilles tendon. This tendon then attaches to the back of the heel bone in the ankle (called the calcaneus). In growing kids, this attachment from tendon to a growth plate in bone is primarily made from cartilage (called the apophysis). The tension caused by the Achilles tendon begins to shear this area, pulling upward on the soft cartilaginous attachment creating pain, inflammation, and sometimes even micro-fractures. Some kids will report the pain is located at the bottom of the heel, some will say the middle, others will say, "it hurts everywhere". Foot positioning can predispose where the most tension will be. For example, if your kid has really flat feet, the area with the most tension may be on the inside of the heel, where most of the tension is occurring in the Achilles Tendon.
The good news is that Sever’s disease will go away when this particular growth plate closes, which is usually between the ages of 14 and 16 years-old. Until then, it is activity limiting, meaning that you can decrease the pain by temporarily decreasing your activity level, in terms of frequency and/or duration. Other ways to decrease the pain may include beginning your sport with a proper sports specific warm-up, and/or changing your shoe wear. If that doesn't work, finding a pediatric sports physical therapist to work with you may be just what you need to get your kid back to playing.
When do I go and see an IPT physical therapist?
In Oregon, Physical Therapy is a direct access medical service, meaning we are front line when musculoskeletal (muscle and bone) issues occur.
With kids, it is very important to call and make an appointment at the beginning of symptoms, not when you are in excruciating pain in the middle of the season.
We even offer complementary visits!
With this in mind, your physical therapy session may include:
Soft tissue massaging and/or joint mobilizations to increase your range of motion at the ankle, knee, hip, or core.
Strengthening the muscles at the hip, knee, using stabilizing muscles (including the core) to decrease the stress on the Achilles.
Balance training, to ensure you are stable on your feet to avoid compensations at the knee and hip.
Teaching proper warm-up, takeoff, and landing strategies for improved jumping/landing mechanics.
Prescribing proper orthotics/heel cups, etc., to better position you feet.
Prescribing home modalities such as ice, contrast baths, and taping techniques to decrease symptoms after games and practices.
Educating coaches, parents, and PE instructors about the disease and prevention efforts.
When do you call your doctor?
The American Academy of Pediatricians suggests you call your doctor if you child exhibits any of the following…
Severe pain,
Swelling that doesn’t decrease or grows worse after 24 hours despite attempting the RICE treatment (REST, ICE, COMPRESSION, ELEVATION),
Fever,
A persistent lump in a muscle,
Limp,
Reddening or increased warmth of the skin overlying the muscle,
Dark urine, especially after exercise (may need emergency support).
Sever’s Disease is a painful childhood disease, but understanding how it happens, and what to do about it,
puts you ahead of the game!
Resources for parents:
American Academy of Pediatrics
American Academy of Orthopedic Surgeons
All information is given for educational purposes only.
Please see your healthcare professional to get a proper evaluation and diagnosis.
Send in your questions for next months blog to Robin@inspireptforkids.com
